Abstract
Background and Purpose. Intravenous thrombolysis using tissue plasminogen activator is safe and probably effective in patients >80 years old. Nevertheless, its safety has not been specifically addressed for the oldest old patients (≥85 years old, OO). We assessed the safety and effectiveness of thrombolysis in this group of age. Methods. A prospective registry of patients treated with intravenous thrombolysis. Patients were divided in two groups (<85 years and the OO). Demographic data, stroke aetiology and baseline National Institute Health Stroke Scale (NIHSS) score were recorded. The primary outcome measures were the percentage of symptomatic intracranial haemorrhage (SICH) and functional outcome at 3 months (modified Rankin Scale, mRS). Results. A total of 1,505 patients were registered. 106 patients were OO [median 88, range 85–101]. Female sex, hypertension, elevated blood pressure at admission, cardioembolic strokes and higher basal NIHSS score were more frequent in the OO. SICH transformation rates were similar (3.1% versus 3.7%, P = 1.00). The probability of independence at 3 months (mRS 0–2) was lower in the OO (40.2% versus 58.7%, P = 0.001) but not after adjustment for confounding factors (adjusted OR, 0.82; 95% CI, 0.50 to 1.37; P = 0.455). Three-month mortality was higher in the OO (28.0% versus 11.5%, P < 0.001). Conclusion. Intravenous thrombolysis for stroke in OO patients did not increase the risk of SICH although mortality was higher in this group.
Highlights
Later years of life are marked by increased vulnerability to some events, such as stroke
The series of patients older than 80 years treated with IV-tPA have had increased mortality, and the proportion of patients with good functional outcome was smaller in comparison with younger patients [6, 7, 18,19,20,21]
Very recently, the Safe Implementation of Treatment in StrokeInternational Stroke Thrombolysis Register (SITS-ISTR) has provided the largest amount of data on the safety and outcome in thrombolysis in patients >80 years of age. This group concluded that these patients had a similar rate of symptomatic intracranial haemorrhage (SICH), and the higher mortality and the poorer functional outcomes were consistent with the overall worse prognosis seen in the natural history of this age group; patients in this age group are appropriate candidates for thrombolysis [25]
Summary
Later years of life are marked by increased vulnerability to some events, such as stroke. The incidence of stroke increases exponentially with age. Different epidemiological studies have shown a rapid increase in the incidence of stroke, with that rate doubling each consecutive decade after 55 years of age and with stroke occurring in more than half of people over 75 years old [1]. The Oxford Vascular Study indicated a 12-fold increase in the incidence of stroke in the OO, compared with the younger population [9]. The OO have higher mortality, morbidity, disability, and greater functional impairment compared with younger patients [10,11,12]. Intravenous thrombolysis using tissue plasminogen activator is safe and probably effective in patients >80 years old. Intravenous thrombolysis for stroke in OO patients did not increase the risk of SICH mortality was higher in this group
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